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Cleveland High School Alumni Association is offering scholarship grants to be used in the 2009-2010academic year to eligible 2009ClevelandHigh School graduates. Each grant will be deposited with the selected recipient’s college, university or vocational/technical school upon verification of acceptance at that institution. The CHSAA scholarship committee must receive completed applications by Thursday,

May 28, 2009. You may submit your application via website The remainder of the materials listed on page 3 of this application to be mailed to: JoAnn Smith, CHSAA Scholarship Committee 4512 196th St SE, Bothell, WA. 98012-7417. You may do this through the CHS office.

Applicant name in full______

Address:______

Phone: ( )______Date of birth ____/____/____ Circle: M or F

Cumulative Grade Point Average______

Senior Project Subject ______

Have you been accepted at a college, university or vocational/technical school?

Yes ______No ______

Which college, university or vocational/technical school do you plan to attend?

______

Field of Studies______

College Student ID#______

Parent(s) or guardian(s) name and address:______

Parent(s) or guardian(s) occupation(s):______

What person has been most influential in your school or personal life: In what way?

______

______

______

Please detail your financial circumstances and needs in order to attend college to reach your academic goals:______

List any scholarships received or applied for:

Name of scholarshipApplied / ReceivedAmount

______

______

______

Did you apply for FAFSA (Free Application for Federal Student Aid)? ______

Will you be receiving funds? ______

Please list any community-oriented activities with which you have been involved:

Please list school activities, positions of leadership and/or honors received:______

______

______

List hobbies and recreational activities______

______

Work experience: List jobs you have held in the past three or four years.

Employment dates

Type of workEmployer from / toHours per week

______

______

______

______

Attach a composition (limited to one typed page) stating your career and educational goals and how this grant would assist you in achieving them.

I certify that this information is true, complete and accurate. I authorize release of information to confirm and/or verify this application.

______

Applicant’s signature Date

Eligibility requirements:

Be a graduating senior

Meet admission requirements of the college, university or vocational/technical school selected

Plan to enroll as full-time (or minimum of 10 quarter hours) student

Submit the following documents together in the order indicated:

  1. This application via website (
  1. Your composition
  2. Certified school transcript
  1. Letter of recommendations from two of your instructors
  1. Copy of your Senior Project
  2. Photo of yourself

Please have your parent or guardian sign the following statement:

I authorize the Cleveland High School Alumni Association to use ______

(student’s name)

photograph to promote their scholarship program and announce recipient awards.

Parent/Guardian’s signature Date

Revised 2/2009